Ann Surg Treat Res.  2020 Apr;98(4):168-176. 10.4174/astr.2020.98.4.168.

Alpha-fetoprotein is correlated with intrahepatic recurrence of hepatocellular carcinoma after a hepatectomy

• Kim H
• Lee SJ
• Yoon M

• KMID: 2500816
• DOI: http://doi.org/10.4174/astr.2020.98.4.168

Abstract

Purpose
Intrahepatic recurrence has a significant effect on the survival of hepatocellular carcinoma (HCC) patients. We aimed to determine if there are useful indicators in predicting the recurrence of liver cancer after a hepatic resection.
Methods
We retrospectively reviewed medical records of 210 HCC patients who underwent hepatectomy between January 2009 and December 2015. We examined clinic-pathological variables comparing 2 groups of HCC patients, either intrahepatic recurrence or not.
Results
We divided 184 patients into 2 groups; 94 patients (51.1%) with intrahepatic recurrence and 90 patients (48.9%) without intrahepatic recurrence. Multivariate analysis showed operation type, preoperative α-FP, postoperative protein induced by vitamin K absence-II (PIVKA-II) elevation, and multiple tumor number were closely associated with intrahepatic recurrence. The preoperative PIVKA-II level was not statistically significant in postoperative intrahepatic recurrence rate. The recurrence rate was 46.2% in 132 of 184 cases of α-FP < 100 ng/mL group. Of the 184 cases, α-FP 100–200 ng/mL were 14 cases (12 cases recurred (85.7%)). Alpha-fetoprotein > 200 ng/mL was 38 of 184 cases, 21 of which recurred (55.3%). According to the multivariate analysis, OR ratio was 8.003 (95% confidence interval [CI], 1.549–41.353) in the α-FP 100–200 ng/mL group and 1.867 (95% CI, 0.784–4.444) in α-FP 200 ng/mL or higher group (P = 0.013). Three-year survival rate of intrahepatic recurrence patients was 80.7%, 3-year survival rate of no intrahepatic recurrence patients was 95.0%.
Conclusion
The intrahepatic recurrence rates were high in the group preop α-FP over 100 ng/mL. Close observation is needed. Prospective study for α-FP genes of HCC patients should be planned for predicting intrahepatic recurrence after hepatectomy.

Keyword

Alpha-fetoproteins; Hepatocellular carcinoma; Recurrence; Survival

Figure

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  Fig. 1 Flow schematic of patients. HCC, hepatocellular carcinoma.

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  Fig. 2 Postoperative intrahepatic recurrence according to preoperative protein induced by vitamin K absence-II (PIVKA-II).

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  Fig. 3 Postoperative intrahepatic recurrence according to preoperative α-FP.

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  Fig. 4 Postoperative intrahepatic recurrence according to preoperative α-FP and postoperative α-FP.

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  Fig. 5 Postoperative intrahepatic recurrence according to preoperative and postoperative protein induced by vitamin K absence-II (PIVKA-II).

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